1. Field of the Invention
The invention relates to orthopedic braces, splints and bandages or the like, and, more particularly, to an elastomeric, orthopedic garment for disorders associated with the upper extremity, including the shoulder girdle. An orthopedic garment in accordance with the invention is provided for supporting and stabilizing the spine and/or one or more given articulations of the upper extremity that have a given disorder, malalignment and/or dysfunction, including without limitation dynamic scapular and acromio-clavicular stabilization, as well as dynamically enhancing proper posture. In other words, the given articulations include but are not limited to a group of joints or ligaments comprising the acromio-clavicular articulation, the coraco-clavicular ligaments, the shoulder joint, and the sterno-clavicular articulation. A central bone among this group of joints and ligaments is the shoulder blade bone, more properly called the "scapula."
2. Prior Art
As various terms of art are used in this written description, some more difficult than others, what follows is a brief overview of the pertinent anatomy, as presented and explained with general reference to FIGS. 1 through 5.
The bones that constitute the "upper extremity" of the human body consist of those of the shoulder girdle, the arm, the forearm and the hand. The shoulder girdle itself consists of two bones, the clavicle and scapula. FIG. 1 shows a rear view of a left scapula 20. The left scapula 20, as representative of a right scapula, is a large, generally flat or planar bone, triangular in shape, situated on the back of the rib cage (not shown) at an upper left border. The scapula 20 generally defines a plane; however, close examination reveals that the scapula 20 is slightly convex (from the rear view vantage point of FIG. 1). The scapula 20's rear surface is subdivided unequally by a spine 22 into two parts. The scapula 20 extends left to right in FIG. 1 between an internal or vertebral border and an external or axillary (i.e., arm pit) border. The spine 22 originates near the internal or vertebral border, and increases in mass as it extends to the external or axillary border, to where, at the margin of the external border, the spine 22 diverges from the plane of the scapula 20 and projects outward or beyond the external border to terminate in a prominence of bone mass, or a bone process formally called the acromion process 24.
The acromion process 24 is formed on its front surface with a concavity (not in view, but occurring at the position indicated by arrow 26) that forms an articulation with the outer extremity of the left clavicle 34 (not shown in FIG. 1, but see FIG. 2). The external or axillary border of the scapula 20 is formed with a cavity 36 called the glenoid cavity. The glenoid cavity 36 is spaced downwardly and slightly forwardly from the acromion process 24 and is the socket which forms the articulation with the humeral head 38 or "ball" (see FIG. 2) in the ball-and-socket joint of the shoulder. Above and in front of the glenoid cavity there is another prominence of bone mass or bone process, called the coracoid process 42.
FIG. 2 shows various articulations of the upper extremity, including the acromio-clavicular articulation 44, the coraco-clavicular ligaments 46, and the shoulder joint. The acromio-clavicular articulation 44 is formed between the outer extremity of the clavicle 34 and the front surface of the acromion process 24, and the ligaments of this articulation are collectively called the acromio-clavicular ligaments. The coraco-clavicular ligaments 46 serve to connect the clavicle 34 with the coracoid process 42 of the scapula 20.
The shoulder joint, as previously mentioned, is a ball-and-socket joint formed by the large globular head of the humerus 38, and the glenoid cavity 36 in the scapula 20, which receives the humeral head 38. The ligaments of the shoulder include a capsular ligament, a coraco-humeral ligament, a glenoid labrum (not shown), as well as the long tendon from the biceps. The capsular ligament generally encircles the ball-and-socket structure, and extends between the circumference of the glenoid cavity 36 in the scapula 20 and the anatomical neck of the humerus. The coraco-humeral ligament is a broad band which reinforces the upper part of the capsular ligament. The glenoid labrum (not shown) is a rim attached round the margin of the glenoid cavity. The long tendon of the biceps inserts as shown and becomes continuous with the glenoid labrum.
FIGS. 3, 4a and 4b show the muscles of the upper trunk, in which FIG. 3 shows the muscles of the upper back and FIGS. 4a and 4b the front of the chest.
With reference to FIG. 3, the muscles of the back are numerous and are for classification purposes subdivided in five layers, only the outer two of which are pertinent here. In the outermost layer is the trapezius muscle 48 which covers the upper back and part of the neck and shoulders. It has an elongated inner border that has an upper termination at the base of the skull and a lower termination down at the base of the dorsal vertebrae, and thus spans the length therebetween adjunct to all the cervical and dorsal vertebrae. From this inner border, the fibers of the trapezius muscle 48 converge as they extend outwardly, to converge on the inner margin of the scapula 20's spine 22 and acromion process 24. In the next layer are the rhomboid muscles 52, which extend in a flat band from an origin or inner border on the spinous process of generally the upper dorsal vertebrae, down and out to an outer extreme attached to the inner border of the scapula 20.
FIG. 4a shows that the muscles of the chest and shoulder area include the pectoral and the deltoid muscles 54, 56 and 58. The pectoralis major muscle 54 has a curved origin or inner border ranging from about the mid-point of the clavicle, and from there arcing in and down about as far as half-way down the sternum 60. The pectoralis major muscle 54 terminates in a flat tendon which is inserted into the humerus (see FIG. 2). The pectoralis minor muscle 56 (see FIG. 4b), which is covered by the pectoralis major muscle 54, terminates in a tendon attached to the coracoid process 42 of the scapula 20. The deltoid muscle 58, as shown by FIG. 4a, gives the rounded outline to the shoulder. Its name comes from its inverted-.DELTA. shape. The deltoid muscle 58 has an extensive origin that arises from (i) the outer third of the clavicle 34, (ii) the acromion process 24 of the scapula 20, as well as from, (ii) the spine 22 of the scapula 20. From this extensive origin the fibers of the deltoid muscle 58 converge to form a tendon inserted in the shaft of the humerus.
FIG. 4b shows an inner layer of muscles of the chest, shoulder and arm area. The long tendon of the biceps attaches to the upper margin of the glenoid cavity 36 of the scapula 20. The short tendon attaches to the coracoid process 42. The serratus anterior (also serratus magnus) muscle 62 originates on the vertebral or inner border of the scapula 20 (refer to FIG. 1), and from there hugs the rib cage to extend to an opposite end where it terminates in a series of fingers attached to the ribs. The subacromial bursa 64 (along with the rotator cuff, discussed below) occupies the interspace between the humeral head 38 and the acromion process 24, and facilitates gliding therebetween. The subscapularis muscle 66 has a diverse origin, but it primarily originates in the subscapular fossa of the scapula 20 (see reference numeral 68 in FIG. 2). From its diverse origin, the subscapularis muscle 66 converges into a tendon attached to the front of the humeral head 38.
FIG. 5 shows the outer extremes of each of the supra-spinatus muscle 70, the infra-spinatus muscle 72, and the teres major and teres minor muscles 74 and 76. The outer extremes of each of these muscles attach to or around the humeral head 38. Three of these tendons, namely, the teres minor 76 and the supra- and infra-spinatus tendons 70 and 72, plus a fourth tendon, the subscapularis tendon 66 (see FIG. 4b), form what is more generally known in orthopedics and sports medicine as the rotator cuff.
The shoulder joint is capable of movement in every direction, namely, forwards (flexion) and backwards (extension), out and up from the side (abduction), and into the side (adduction), as well as rotation (spinning) inwards (internal rotation) and outwards (external rotation), plus circumduction (pivoting). The scapula 20 is capable of being moved upwards (elevation) and downwards (depression), forwards (protraction) and backwards (retraction), as well as circumduction (pivoting) from a given resting alignment out and up (lateral or upward rotation), or in and down (medial or downward rotation), over the back of the rib cage. The muscles which raise the scapula 20 include the upper fibers of the trapezius 48 and the two rhomboids 52; those which depress it include the lower fibers of the trapezius 48 and the pectoralis minor 56. The scapula 20 is drawn backwards by the rhomboids 52 and the middle and lower fibers of the trapezius 48, and forwards by the serratus anterior 62 and pectoralis minor 56, assisted by, when the arm is fixed, the pectoralis major 54. The literature indicates the average range for scapular elevation and depression is between 10 and 12 cm, the average amount of protraction and retraction is 15 cm, and the average range of circumduction (pivoting) is between opposite extremes about 60.degree. apart. See, e.g., K. Andeway, "Scapular Malalignment in Upper Quadrant Dysfunction," in PT Magazine, July 1994, pp. 60-65.
There are various disorders or pathologies to the areas of the neck, the shoulder, the upper trunk as well as the temporo-mandibular joint (i.e., the jaw), the treatment of which can involve proper dynamic positioning of the posture and/or dynamic stabilization of the scapula, as will be more fully explained below. What is needed is an effective orthopedic garment for properly, dynamically positioning the posture and/or dynamically stabilizing the scapula, which garment can be dressed into by a patient, male or female, without outside or professional help (following, of course, an original fitting and course of instruction in the use of the garment), and which is multiply adjustable for comfort and/or special support, wearable under regular clothing, re-usable, economical, and non-allergenic to the skin of the patient.